LWBK1006-34 LWW-Govindan-Review November 24, 2011 11:25
CHAPTER 34 PLASMA CELL
NEOPLASMS
RAVI VIJ•GIRIDHARAN RAMSINGHDIRECTIONS Each of the numbered items below is followed by lettered answers. Select the
ONE lettered answer that is BEST in each case unless instructed otherwise.QUESTIONS
Question 34.1. An 80-year-old woman presents to the emergency department with pro-
gressive low back pain for 3 weeks. On examination, she has tender-
ness at multiple levels on her spine but no neurological deficits. She has
an Eastern Cooperative Oncology Group (ECOG) performance status
of 2. Laboratory testing shows a hemoglobin (Hb) of 7.8 g/dL, crea-
tinine of 2.1 mg/dL, calcium of 8.8 mg/dL, and albumin of 4.1 g/dL.
She has a skeletal survey showing multiple osteolytic lesions, including
multiple vertebral compression fractures. She has a serum protein elec-
trophoresis (SPEP) showing a monoclonal protein of 6.2 g/dL. Serum
immunofixation shows a monoclonal immunoglobulin (Ig)G kappa light
chain protein. Her beta-2 microglobulin level is 5.3 mg/L. She has a bone
marrow biopsy that shows a hypercellular marrow with 60% plasma
cells, and cytogenetic analysis reveals a normal female karyotype. Of
the following treatment options, which would be considered the MOST
appropriate?
A. Melphalan and prednisone (MP)
B. Melphalan, prednisone, and thalidomide (MPT)
C. Thalidomide and dexamethasone (TD)
D. Melphalan 100 mg/m^2 followed by autologous stem cell transplan-
tationCorresponding Chapter inCancer: Principles & Practice of Oncology,Ninth Edition: 136 (Plasma Cell Neoplasms).463